Nuclear medicine technologists are able to accurately determine when a myocardial perfusion rest study is necessary

Abstract

BackgroundIn myocardial perfusion scintigraphy (MPS), typically a stress and a rest study is performed. If the stress study is considered normal, there is no need for a subsequent rest study. The aim of the study was to determine whether nuclear medicine technologists are able to assess the necessity of a rest study.MethodsGated MPS using a 2-day 99mTc protocol for 121 consecutive patients were studied. Visual interpretation by 3 physicians was used as gold standard for determining the need for a rest study based on the stress images. All nuclear medicine technologists performing MPS had to review 82 training cases of stress MPS images with comments regarding the need for rest studies, and thereafter a test consisting of 20 stress MPS images. After passing this test, the nuclear medicine technologists in charge of a stress MPS study assessed whether a rest study was needed or not or if he/she was uncertain and wanted to consult a physician. After that, the physician in charge interpreted the images and decided whether a rest study was required or not.ResultsThe nuclear medicine technologists and the physicians in clinical routine agreed in 103 of the 107 cases (96%) for which the technologists felt certain regarding the need for a rest study. In the remaining 14 cases the technologists were uncertain, i.e. wanted to consult a physician. The agreement between the technologists and the physicians in clinical routine was very good, resulting in a kappa value of 0.92. There was no statistically significant difference in the evaluations made by technicians and physicians (P = 0.617).ConclusionsThe nuclear medicine technologists were able to accurately determine whether a rest study was necessary. There was very good agreement between nuclear medicine technologists and physicians in the assessment of the need for a rest study. If the technologists can make this decision, the effectiveness of the nuclear medicine department will improve.

Multicenter evaluation of stress-first myocardial perfusion image triage by nuclear technologists and automated quantification

“…A retrospective study of 121 patients found an accuracy of 88.8% for the technologists agreement with a consensus read reference standard for determining the need for rest images in a stress-first MPI protocol. 10 However, 14 of the patients were excluded from analysis as the technologists were able to choose an “uncertain” categorization if they wanted a physician's input. In a very interesting epilog, this particular laboratory in Malmö, Sweden converted to the routine of having the technologists determines the need for rest images in general practice and found that in a specified period of time, 56.4% of studies required rest images compared to 56.2% during an earlier period of time when physicians made the determination.…”

“…Another option to overcome the need for immediate stress image review is to take advantage of the two resources that are always available when perfusion imaging is performed: experienced nuclear technologists and automated computer quantification. There is scant literature assessing the ability of nuclear technologists to determine the need for a rest study with stress-first MPI, 9,10 and only tangential literature on automated quantification. 11,12 …”